M21-1, Part III, Subpart i, Chapter 3, Section B - Processing Fully Developed Claims (FDCs)

Overview

In This Section

This section contains the following topics:

Topic	Topic Name
1	Intake Process for FDCs
2	Excluding Claims From the FDC Program
3	Development the Department of Veterans Affairs (VA) Undertakes in Connection with FDCs
4	Determining the Appropriate Effective Date for a Grant of Benefits Under the FDC Program
5	Revisions of FDC Decisions
6	FDC Folder Flash

1. Intake Process for FDCs

Introduction

This topic contains information about the intake process for the receipt of FDCs, including

initial actions to take upon receipt of an FDC with an electronic claims folder (eFolder), and
initial actions to take upon receipt of an FDC for claims with paper claims folders.

Change Date

August 6, 2015

III.i.3.B.1.a. Initial Actions to Take Upon Receipt of an FDC with an eFolder

Take the following actions within one day of receipt of a fully developed claim (FDC) when there is an electronic claims folder (eFolder)

establish the appropriate end product (EP)
enter specific contentions of the claim, and
identify the claim as an FDC by attaching the Fully Developed Claimspecial issue indicator to at least one contention within the FDC claim.

References: For more information about

choosing an appropriate EP, see M21-4, Appendix B, and
establishing a claim in the appropriate system, see M21-1, Part III, Subpart ii, 3.D.2.

III.i.3.B.1.b. Initial Actions to Take Upon Receipt of an FDC for Claims With Paper Claims Folder

Take the following actions within one day of receipt of an FDC that has a paper claims folder

establish the appropriate EP
enter specific contentions of the claim
identify the claim as an FDC by attaching the Fully Developed Claimspecial issue indicator to at least one contention within the FDC claim
complete the folder flash shown in M21-1, Part III, Subpart i, 3.B.6 and attach it to the paper claims folder, and
deliver the paper claims folder to the designated drop-off point for FDCs that require the development described in M21-1, Part III, Subpart i, 3.B.3.

Note: A paper claims folder is a claims folder that has not yet been scanned into the electronic claims processing system.

References: For more information about

choosing an appropriate EP, see M21-4, Appendix B
establishing an EP in the appropriate system, see M21-1, Part III, Subpart ii, 3.D.2, or
drop-off points for FDCs, see M21-1, Part III, Subpart i, 3.A.3.c.

2. Excluding Claims From the FDC Program

Introduction

This topic contains information about excluding claims from the FDC Program, including

Change Date

February 19, 2019

III.i.3.B.2.a. Excluding a Claim From the FDC Program at CEST

Even though a claimant submits one of the EZ forms listed in M21-1, Part III, Subpart i, 3.A.2.a, the claim must be reviewed at the claims establishment stage to ensure it qualifies for FDC processing.

Use the table below when establishing a claim submitted on an EZ form to determine if it must be excluded from the FDC Program.

If …	Then …
the claimant indicates he/she does *notwant the Department of Veterans Affairs (VA) to process his/her claim under the FDC Program (as discussed in M21-1, Part III, Subpart i, 3.A.2.b) has a claim pending at the time VA receives the EZ form has a legacy appeal, higher-level review (HLR), or notice of disagreement (NOD) with the Board of Veterans’ Appeals (BVA) pending at the time VA receives the EZ form, or fails to simultaneously*submit any of the additional forms required to process his/her specific claim	exclude the claim from the FDC Program. *Note: Required forms are defined as those forms discussed on the EZ form under “Special Circumstances.” Exception: If evidence submitted with the FDC is sufficient to concede a stressor in a posttraumatic stress disorder (PTSD) claim, such as fear, combat decoration, etc., a VA Form 21-0781,Statement in Support of Claim for Service Connection for Post-traumatic Stress Disorder (PTSD), is not required. Reference*: For more information on PTSD claims, see M21-1, Part III, Subpart iv, 4.O, and M21-1, Part IV, Subpart ii, 1.D.
the claim requires development for evidence from the claimant, or private medical care provider(s)	exclude the claim from the FDC Program. *Exception*: Special issue claims as discussed in M21-1, Part III, Subpart i, 3.B.3.d.
the claim requires development for Federal records *Note: This includes development forVA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA), and/or VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs*, if required to obtain Vet Center records or military treatment facility (MTF) records relating to sensitive diagnoses.	do not exclude the claim from the FDC Program. *References*: For more information on FDCs and Vet Center records, see M21-1, Part III, Subpart i, 3.B.3.f, and obtaining sensitive MTF records, see M21-1, Part III, Subpart iii, 1.C.3.b and c.
the claim requires development for National Guard or reserve unit records	do not exclude the claim from the FDC Program.
the claim requires completion of NA Form 13055, Request for Information Needed to Reconstruct Medical Data, (by the claimant) because service treatment records (STRs) were destroyed by a fire at the National Personnel Records Center (NPRC) in 1973	do not exclude the claim from the FDC Program.
the claim requires a character of discharge determination	exclude the claim from the FDC Program.
the claim requires a telephone call to a claimant to clarify information	do not automatically exclude from the FDC Program. *Reference*: For more information on telephone contact and FDC exclusion, see M21-1, Part III, Subpart i, 3.B.3.i.
VA requires a claimant to simultaneously submit an additional form with his/her FDC, and the claimant submits an incomplete form	exclude the claim from the FDC Program. *Note*: Required forms are defined as those forms discussed on the EZ form under “Special Circumstances.”
VA requires independent verification of earned and unearned income from Federal tax information (FTI) received for upfront verification	exclude the claim from the FDC Program.
a claimant submits a dual claim for compensation and pension on the required EZ forms, and one of the claims requires further development	the claim that does not require development should still be processed in the FDC Program.

Notes:

Benefits Delivery at Discharge (BDD) claims are excluded from the FDC Program. However, claims that are excluded from the BDD program (including BDD-excluded claims received from 180 to 1 day prior to discharge, and claims or additional contentions received less than 90 days prior to discharge) can be processed through the FDC Program subject to FDC Program requirements.
The steps described in M21-1, Part III, Subpart i, 3.B.2.d do not apply when excluding a BDD claim.

References: For more information on the

only development VA will undertake in connection with an FDC, see M21-1, Part III, Subpart i, 3.B.3.a, and
required procedure for excluding a claim from the FDC Program, seeM21-1, Part III, Subpart i, 3.B.2.d.

III.i.3.B.2.b. Reasons for Subsequent Exclusion of a Claim From the FDC Program

If at any time during the processing of an FDC, a reason for exclusion is met, the claim must be excluded from the FDC Program.

See the table below for a description of the reasons for subsequent exclusion of a claim from the FDC Program.

Important: When guidance on excluding an FDC has changed during the processing of the FDC, follow the instructions in M21-1, Part III, Subpart i, 3.B.2.g.

Exclude a claim from the FDC Program if the claimant or power of attorney (POA) …	Except …
submits additional evidence, even if it does not require additional development.	as provided in M21-1, Part III, Subpart i, 3.B.2.c.
fails to report for a VA examination, and asks VA to reschedule beforethe FDC is decided.	if VA is solely at fault. *Example*: VA did not provide the examining facility with the claimant’s correct mailing address.
submits an additional claim, even if it does not require additional development.	when a survivor’s FDC is either preceded or followed by a burial or accrued claim, or when there is an unclaimed issue that is found to be within the scope of the claim as defined in 38 CFR 3.155(d)(2). Any issue within the scope of the claim will be developed in accordance with current policies and procedures and will not be excluded for any non-Federal records development. *Reference*: For more information on issues within the scope, see M21-1, Part III, Subpart iv, 6.B.1.c.
submits a(n) legacy appeal request for HLR, or NOD to BVA.	—

III.i.3.B.2.c.Submission of Additional Evidence and FDC Exclusion

In some cases, the submission of additional evidence does not require an automatic exclusion from the FDC Program. Do not exclude a claim from the FDC Program if the claimant or his/her POA submits

duplicate evidence already of record, including records not in the eFolder but in other VA systems, such as the Compensation and Pension Record Interchange
a response limited to only the information requested in a required development letter
status or Inquiry Routing and Information System inquiries, or
information received in response to a matching/data transfer program between VA and another government entity.

Reference: For more information on the determination to exclude from the FDC Program after sending a development letter, see M21-1, Part III, Subpart i, 3.B.3.h.

III.i.3.B.2.d. Process for Excluding a Claim From the FDC Program

If it becomes necessary to exclude a claim from the FDC Program, regional offices (ROs) must follow the steps in the table below.

Exception: The steps in the table below do not apply when excluding a BDD claim. These claims do not require claimant notification or an FDC exclusion special issue indicator.

Step	Action
1	Remove the FDC folder flash, if one exists.
2	Replace the Fully Developed Claim special issue indicator with the appropriate special issue indicator from the list in M21-1, Part III, Subpart i, 3.B.2.e.
3	Notify the claimant that VA has excluded his/her claim from the FDC Program by sending one of the following: the FDC Writeout Letter from the Letter Creator tool if development to the claimant is required and the claim is being excluded, the relevant language from the Letter Creator tool free texted into the subsequent development letter, or equivalent letter from Personal Computer Generated Letters (PCGL). *Note: This notice is not* required to the claimant if the reason for exclusion is because he or she declined FDC processing. *References: For more information on the Letter Creator tool, see the Letter Creator User Guide, and PCGL, see PCGL User Guide*.
4	Continue processing the claim under standard claims-processing procedures.

Note: After excluding a claim from the FDC Program, provide the claimant with the notice 38 U.S.C. 5103 required only if VA excluded the claim because the claimant

did not submit his/her claim on one of the EZ forms – or the appropriateEZ form – listed in M21-1, Part III, Subpart i, 3.A.2
submitted a non-original claim on the appropriate EZ form before March 24, 2015, but did not sign the form, or
submitted another claim after VA received the FDC and VA has not provided Section 5103 notice (to include the notice the EZ forms provide) within the last year that covers the issue(s) in the subsequent claim.

Important: An unsigned application for benefits received on or after March 24, 2015, must be handled as an incomplete application as instructed in M21-1, Part I, 1.B.1.g.

References: For more information on

the notice 38 U.S.C. 5103 requires, see M21-1, Part I, 1.B
signatures, see M21-1, Part III, Subpart ii, 1.C.2, and
handling unsigned applications, see
- M21-1, Part III, Subpart i, 3.A.2.i, and
- M21-1, Part III, Subpart ii, 2.B.3.f.

III.i.3.B.2.e. Special Issue Indicators and Required Notification for FDC Exclusion

If it is necessary to exclude a claim from the FDC Program,

send the claimant the appropriate notification explaining the relevant exclusion reason as described in M21-1, Part III, Subpart i, 3.B.2.d, and
assign the appropriate FDC special issue indicator.

Use the table below to select the appropriate special issue and notification text.

Exclusion Reason	Special Issue	FDC Writeout Letter Selection
Claimant declines FDC processing	FDC Excluded – Claimant declined FDC processing	N/A
Claim is pending at the time VA receives the FDC	FDC Excluded – Claim pending	Claim pending at time of receipt of FDC Application
Legacy appeal, HLR, or NOD to BVA is pending at the time VA receives the FDC	FDC Excluded – Appeal pending	Appeal pending at time of receipt of FDC Application
Claimant fails to simultaneously submit any of the additional forms required to process his/her specific claim	FDC Excluded – All Required Items Not Submitted	FDC Application was not submitted with all items required to process claim
The claim requires development for evidence, or a character of discharge determination	FDC Excluded –Needs Non-Fed Evidence Development	Development for Non-Federal evidence required
VA requires independent verification of earned and unearned income from FTI received for upfront verification	FDC Excluded – Requires INDPT VRFCTN of FTI	Independent verification of Federal Tax Information (FTI) required
The claimant or POA submits additional evidence	FDC Excluded – Evidence received after FDC CEST	Evidence received after claim was established
The Veteran fails to report for a VA examination, and asks VA to reschedule before the FDC is decided	FDC Excluded – FTR to exam	Veteran failed to report to an exam and requested rescheduling
The claimant or POA submits an additional claim	FDC Excluded – Additional claim submitted	Additional claim submitted
The claimant or POA submits a(n) legacy appeal request for HLR, or NOD to BVA	FDC Excluded—Appeal Submitted	Appeal submitted while FDC was pending

References: For more information on

the Letter Creator tool, see the Letter Creator User Guide, and
PCGL, see PCGL User Guide.

III.i.3.B.2.f. Erroneous Exclusion of a Claim From the FDC Program

When a claim has been erroneously excluded from the FDC Program, VA must

remove the FDC exclusion special issue indicator
add the Fully Developed Claim special issue indicator back to at least one contention, and
continue to process the claim in the FDC Program.

Notes:

If a claim is erroneously excluded from the FDC Program, the rating activity must still apply all applicable FDC effective date rules.
Notice to the claimant that the claim was erroneously excluded is not required. Any discussion of the effective date awarded in the rating decision and award notification letter is sufficient.

III.i.3.B.2.g. Applicability of FDC Guidance Changes

Use the table below to determine the appropriate action when changes in guidance occur during the processing of an FDC.

If during the processing of the FDC, the claim …	And under new guidance in effect at the time the decision is being made …	Then …
was excluded from the FDC Program	it would not be excluded *Examples*: National Guard records not submitted with the claim, or fire-related STRs.	provided the claim is an original compensation claim, follow the provisions of M21-1, Part III, Subpart i, 3.B.2.f to reinstate the claim into the FDC Program.
did not meet a reason to exclude	the claim would be excluded *Examples*: Claims processed between March 11, 2015, and August 6, 2015, with additional evidence received that did not require additional development. Claims processed between December 2014 and August 6, 2015, where additional contentions were received that did not require additional development.	leave the claimant in the FDC Program, and apply the new guidance prospectively to claimed issues not previously reviewed/considered.

3. Development VA Undertakes in Connection with FDCs

Introduction

This topic contains information about development VA undertakes in connection with FDCs, including

Change Date

February 19, 2019

III.i.3.B.3.a. Limitations on the Development of FDCs

The only development VA undertakes in connection with an FDC is to request

Federal records in the custody of the Federal government, including
- FTI as described in M21-1, Part X, 9.A.1
- records in the custody of VA medical centers
- relevant records at an MTF, including development for a VA Form 21-4142 and/or VA Form 21-4142a, for MTF records relating to a sensitive diagnosis
- records that were destroyed by a fire at NPRC in 1973, and
- records in the custody of a Veteran’s Reserve/Guard unit(s)
VA Form 21-4142 and/or VA Form 21-4142a when needed to obtain Vet Center records
information needed for special issue claims
clarifications by telephone contact with the claimant, and/or
a VA examination.

Notes: When submitting a request for records from a Federal records custodian in connection with an FDC

inform the records custodian that VA
- is making the request in connection with an FDC, and
- requests expedited assistance in obtaining the records, and
do not concurrently request the same records from the claimant.

Reference: For more information on requesting records from an MTF, see M21-1, Part III, Subpart iii, 2.B.4.

III.i.3.B.3.b. Handling the Final Notification Letter for Federal Records

If it becomes apparent that records VA requested from a Federal records custodian in connection with an FDC are unavailable, follow the instructions in M21-1, Part III, Subpart iii, 1.C.1.e.

In addition to the notice elements described in M21-1, Part I, 1.C.5.b, include the following in the final notification letter:

We received your claim and your request to participate in the Fully Developed Claim (FDC) Program. Though you indicated you have no other information or evidence to give VA to support your claim, we are required to send you this notice. If you have information or evidence not previously submitted to VA that supports your claim, we recommend you submit it. As a reminder, if you identify or submit any additional information or evidence at this point, VA will remove your claim from the FDC Program and process it under standard claims-processing procedures.

III.i.3.B.3.c. Requesting an Examination in Connection With an FDC

When requesting an examination in connection with an FDC, inform the examining facility that VA is

making the request in connection with an FDC, and
asking for expeditious handling of the request.

III.i.3.B.3.d. FDCs and Special Issue Development

If an FDC includes one of the special issues that require a subsequent development letter as noted in M21-1, Part I, 1.B.1.f, FDC exclusion is notappropriate at claims establishment as there was no prior notice to the claimant to provide the additional information/evidence necessary to develop and adjudicate the claim.

Exception: Claims falling under one of the “Special Circumstances” noted on Page 2 of VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, such as PTSD or individual unemployability, must be excluded from the FDC Program if filed without the necessary additional form(s) and adequate supporting evidence is not already of record.

Important: Do not send the development letter if the evidence of record

provides the information the letter solicits, or
is otherwise sufficient to decide the claim.

Example: If a Veteran claiming service connection (SC) for hepatitis C submits medical records that address risk factors for the disease, do not send a letter soliciting hepatitis risk factors, as this information is addressed by the evidence of record.

References: For more information on

military sexual trauma (MST) protocol and FDCs, see M21-1, Part III, Subpart i, 3.B.3.e, and
exclusion from the FDC Program at claims establishment, see M21-1, Part III, Subpart i, 3.B.2.a.

III.i.3.B.3.e. MST Protocol and FDCs

MST claims require special handling and contact with the claimant. Development to a claimant that aligns with MST protocol will not be an exclusion from the FDC Program. Do not exclude MST claims from the FDC Program based on

a telephone call to a claimant to inquire as to whether or not any other claims of the MST have been filed, or
development to a claimant for an incident report.

Reference: For more information on notification requirements for special issue claims, see M21-1, Part I, 1.B.1.f.

III.i.3.B.3.f. FDCs and Vet Center Records

FDC exclusion is not appropriate at claims establishment when a Veteran identifies Vet Center records that require completion of a VA Form 21-4142 and/or VA Form 21-4142a, as there is no prior notice to the claimant that these Federal records require a release form.

RO personnel should request that the claimant provide the VA Form 21-4142 andVA Form 21-4142a for the Vet Center records, when required, and include the language shown in M21-1, Part III, Subpart i, 3.B.3.g.

Important: If the claimant responds with only the requested form or the related records, the claim will remain in the FDC Program.

Reference: For more information on the determination to exclude from the FDC Program after sending a development letter, see M21-1, Part III, Subpart i, 3.B.3.h.

III.i.3.B.3.g. Additional Language for FDC Development Letters

Some FDCs require additional requests for information from the claimant because the upfront notification on the claims form does not adequately inform the claimant of the evidence required to substantiate the claim. These include

certain special issue claims,
MTF records related to a sensitive diagnosis, and
Vet Center records.

In these cases, when an FDC requires a development letter, ROs must enter the following text under the FREE TEXT menu, Important Information section:

You submitted your claim under the Fully Developed Claim (FDC) Program; however, we need additional information from you. Since your claim is part of the FDC Program, if you submit evidence other than what is requested below, your claim will be excluded from the FDC Program.

References: For more information on

notification requirements for special issue claims, see M21-1, Part I, 1.B.1.f
FDCs and special issue development, see M21-1, Part III, Subpart i, 3.B.3.d,
obtaining sensitive MTF records, see M21-1, Part III, Subpart iii, 1.C.3.b and c, and
FDCs and Vet Center records, see M21-1, Part III, Subpart i, 3.B.3.f.

III.i.3.B.3.h. Determination to Exclude from the FDC Program After Sending a Development Letter

Use the table below to determine whether a claim should be excluded from FDC processing after sending the required development letter to the claimant.

If the claimant …	Then …
provides only the information requested in the development letter *Example: VA requested a VA Form 21-4142* and VA Form 21-4142a from the claimant for Vet Center records. The claimant submits the records in lieu of the form.	do not exclude from the FDC Program.
submits additional information/evidencenot requested in the development letter	exclude from the FDC Program.
does not respond to the development letter	do not exclude from the FDC Program.

References: For more information on

notification requirements for special issue claims, see M21-1, Part I, 1.B.1.f
steps to take when a claim is excluded from the FDC Program, see M21-1, Part III, Subpart i, 3.B.2.d, and
special issue development procedures, see the relevant section(s) within M21-1, Part IV, Subpart ii, 1.

III.i.3.B.3.i. Telephone Development and FDC Exclusion

A telephone call to a claimant to clarify information will not require exclusion from the FDC Program if the telephone call can be completed at the time the action is being taken on the claim. Exclusion would be appropriate when contact with the claimant is unsuccessful and the need for clarification would require the initiation of additional development.

Example: A claimant submits medical evidence from a physician and attaches aVA Form 21-4142 or VA Form 21-4142a. The Veterans Service Representative (VSR) calls the claimant to clarify if the claimant wanted VA to develop for additional records. Provided the VSR reaches the claimant the same day and the claimant provided a negative response, the claim will not be excluded from the FDC Program.

Important: Exclusion would be appropriate if

the claimant cannot be reached at the time of the action being taken on the claim, and
VA then had to send a letter to the claimant to request the necessary information.

4. Determining the Appropriate Effective Date for a Grant of Benefits Under the FDC Program

Introduction

This topic contains instructions for determining the appropriate effective date for a grant of benefits under the FDC Program, including

Change Date

February 19, 2019

III.i.3.B.4.a. Determining the Appropriate Effective Date for a Grant of Benefits Under the FDC Program

VA law allows for several circumstances whereby a Veteran may be assigned an effective date for payment that is earlier than the date VA received the claim. There are several bases decision makers must consider for retroactive effective dates, such as

original FDCs
claims filed within one year of discharge
claims for increase, and
liberalizing law changes.

When granting claims under the FDC program, consider each rule for assigning an effective date separately, and assign the most advantageous effective date that applies to the facts of the case.

Important: Only one effective date law can be used for each service-connected disability granted.

See the table below for considerations when assigning a retroactive effective date to an FDC.

If the FDC is …	Then consider entitlement to an effective date prior to date of claim under …
an original compensation claim received between August 6, 2013, through August 5, 2015	Public Law (PL) 112-154, Section 506.
an original claim for compensation received within a year after an intent to file (ITF), and the ITF was received between March 24, 2015, through August 5, 2015	PL 112-154, Section 506. *Note: The provisions of Section 506* of PL 112-154 do not apply to informal claims filed prior to March 24, 2015, under historical 38 CFR 3.155.
a claim for increase	38 CFR 3.400(o).
affected by liberalizing legislation	38 CFR 3.114(a).
received from a recently discharged Veteran	38 CFR 3.400(b)(2)(i).

Note: Under PL 112-154, Section 506, an original claim is the initial formal (complete) claim filed by a Veteran for disability compensation. Consequently, a Veteran who has applied for non-service-connected pension in the past is potentially eligible for a retroactive date under PL 112-154, Section 506 upon filing an original FDC for disability compensation.

III.i.3.B.4.b. Instructions for Applying the Provisions of Section 506 of PL 112-154

When application of the provisions of Section 506 of PL 112-154 is in order, the proper effective date for a grant of benefits is whichever of the following dates is most advantageous to the claimant based upon the facts of the case:

one year prior to the date VA receives a formal and complete FDC for the benefit granted
one year prior to the date VA receives an ITF, provided a complete FDC is received within one year of the date of receipt of the ITF, or
the date entitlement to the claimed benefit arose.

Notes:

To deny entitlement to a retroactive effective date under PL 112-154, there must be conclusive and persuasive evidence that the claimed disability did not exist during the retroactive period. In all cases, reasonable doubt should be resolved in favor of the claimant.
A decision to assign the date entitlement arose as the effective date must be based on evidence of record that affirmatively shows the onset of a claimed disability occurred after the date of claim or after any applicable retroactive period.
If a claimant submits an incomplete FDC, as described in M21-1, Part III, Subpart i, 3.A.2.j and k, the rating activity must select whichever effective date is most advantageous to the claimant (the date of receipt of the incomplete FDC or one year prior to the date VA received the formal FDC). However, under no circumstances may VA grant benefits from an effective date prior to the date entitlement to the claimed benefit arose.
The disability evaluation that the rating activity assigns effective the beginning of the retroactive period should remain static throughout the retroactive period unless the evidence of record clearly supports a staged rating. If a staged rating is warranted, the rating activity must
- clearly explain in the rating decision the rationale for it, and
- identify the evidence that made the staged rating necessary.

III.i.3.B.4.c. Explaining FDC Effective Dates

See the table below for additional explanation required in the rating decision when assigning effective dates in FDC claims.

When the rating activity …	Then include the following text in the rating decision narrative …
assigns a retroactive effective date under the provisions of Section 506 of PL 112-154	Effective date assigned via Section 506 of PL 112-154.
assigns an earlier effective date based on some other provision	The one year retroactive effective date for FDC claims was considered, but we were able to assign an earlier effective date under [insert effective date rule applied and explanation].

Reference: For more information on the rating decision narrative, see M21-1, Part III, Subpart iv, 6.C.

<iii.i.3.b.4.dIII.i.3.B.4.d. Example 1: Proper Application of the Provisions of Section 506 of PL 112-154</iii.i.3.b.4.d

Scenario:

On January 3, 2013, a Veteran begins the process of filing an original FDC for SC for a knee disorder through Veterans Online Application (VONAPP) Direct Connect (VDC).
The Veteran submits her online application to VA on September 1, 2013.
VA reviews the application, determines it is complete, and accepts it as a formal FDC.
Evidence of record confirms the knee disorder is service-related and has been severe enough to justify the assignment of a 30-percent evaluation for several years.

Result: On December 12, 2013, VA granted the Veteran’s claim and assigned a 30-percent disability evaluation to the knee, effective September 1, 2012.

Rationale:

The act of beginning the process of filing a claim through VDC on January 3, 2013, constitutes submission of an incomplete FDC for benefits on that date.
Because the Veteran submitted a formal FDC within one year of submitting the incomplete FDC, she became potentially entitled to benefits from January 3, 2013.
Because the Veteran submitted a formal FDC after August 5, 2013, andbefore August 6, 2015, the provisions of Section 506 of PL 112-154 apply, making the Veteran potentially entitled to benefits effective one year prior to the date VA received her formal FDC.
VA granted entitlement to benefits for the knee disorder effective September 1, 2012, because
- doing so provided greater benefit for the Veteran than granting entitlement from the date of the incomplete FDC, and
- the evidence of record confirmed the severity of the Veteran’s knee disorder justified the assignment of a 30-percent disability evaluation on that date.

Reference: For more information on identifying an incomplete FDC, see M21-1, Part III, Subpart i, 3.A.2.j.

III.i.3.B.4.e. Example 2: Proper Application of the Provisions of Section 506 of PL 112-154

Scenario:

On April 15, 2015, VA received VA Form 21-0966, Intent to File a Claim For Compensation and/or Pension, or Survivors Pension and/or DIC, from a Veteran.
On March 30, 2016, VA received a formal and complete FDC from the Veteran for SC for asthma.
Private medical evidence submitted with the claim showed the Veteran was first diagnosed with asthma on September 15, 2015.

Result: VA granted SC for asthma effective September 15, 2015, which represents the earliest date medical evidence confirmed a diagnosis of asthma.

Rationale: The assignment of an effective date of April 15, 2014, one year retroactive to the date of receipt of the ITF, is improper for two reasons:

the medical evidence of record affirmatively showed the Veteran was not diagnosed with asthma until September 15, 2015, and
there was no other lay or medical evidence indicating asthma manifested prior to such date.

Important: If the medical or other evidence submitted with the FDC did not clearlyshow this was the Veteran’s first complaint and/or diagnosis, then the Veteran should be afforded the benefit of the doubt and awarded the full one year retroactive effective date from the date of receipt of the ITF.

5. Revisions of FDC Decisions

Introduction

This topic contains instructions for processing revisions of decisions made under the FDC Program, including

Change Date

February 19, 2019

III.i.3.B.5.a. Handling Disputes With Exclusion from the FDC Program

A legacy NOD or request for decision review filed by a claimant in response to a notice that the claim was excluded from the FDC Program is not considered valid. Send notice to the claimant that the submission is not considered valid as no final decision had been made at the time he/she expressed disagreement.

If the claimant timely disagrees with or requests decision review regarding exclusion from the FDC Program after notice of the rating decision on the excluded claim,

accept it as a valid legacy NOD or request for decision review, and
address in the review decision whether the appropriate effective date was originally assigned.

References: For more information on

the definition of a legacy NOD, see M21-1, Part I, 5.A.1.d, and
legacy NODs, see M21-1, Part I, 5.B.

III.i.3.B.5.b. Granting the FDC Retroactive Effective Date During the Legacy Appeal Period

A legacy appellant may qualify for a retroactive effective date under PL 112-154, Section 506, even if the legacy NOD is received on or after August 6, 2015. The issue as to whether the FDC retroactive effective date applies is whether the Veteran successfully made it to the initial rating decision as a member of the FDC Program. Once the initial rating decision is issued, there is no further need to determine whether to exclude the Veteran from the program.

If the Veteran meets all other requirements for the retroactive effective date underPL 112-154, Section 506, the FDC effective date should be awarded to any original grant of SC based on a

legacy
- appeal, or
- claim for reconsideration with new evidence received within one year of the prior denial under 38 CFR 3.156(b), or
clear and unmistakable error in the prior denial under 38 CFR 3.105(a).

Note: A separate claim can co-exist with the legacy appeal without disqualifying the appeal from being considered under the FDC Program’s guidelines.

6. FDC Folder Flash

Change Date

August 6, 2015

III.i.3.B.6.a. FDC Folder Flash

The image below represents the folder flash ROs must attach to a paper claims folder associated with an FDC.

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Last Updated: 1 year ago in Chapter 3 Fully Developed Claim (FDC) Program and Decision Ready Claim (DRC) Initiative, Part III General Claims Process, Subpart i Overview of Claims Processing and Structure of the Veterans Service Center (VSC)

Did this article answer your question?

M21-1, Part III, Subpart i, Chapter 3, Section B – Processing Fully Developed Claims (FDCs)

Overview

In This Section

1. Intake Process for FDCs

Introduction

Change Date

III.i.3.B.1.a. Initial Actions to Take Upon Receipt of an FDC with an eFolder

III.i.3.B.1.b. Initial Actions to Take Upon Receipt of an FDC for Claims With Paper Claims Folder

2. Excluding Claims From the FDC Program

Introduction

III.i.3.B.2.a. Excluding a Claim From the FDC Program at CEST

III.i.3.B.2.b. Reasons for Subsequent Exclusion of a Claim From the FDC Program

III.i.3.B.2.c.Submission of Additional Evidence and FDC Exclusion

III.i.3.B.2.d. Process for Excluding a Claim From the FDC Program

III.i.3.B.2.e. Special Issue Indicators and Required Notification for FDC Exclusion

III.i.3.B.2.f. Erroneous Exclusion of a Claim From the FDC Program

III.i.3.B.2.g. Applicability of FDC Guidance Changes

3. Development VA Undertakes in Connection with FDCs

Introduction

Change Date

III.i.3.B.3.a. Limitations on the Development of FDCs

III.i.3.B.3.b. Handling the Final Notification Letter for Federal Records

III.i.3.B.3.c. Requesting an Examination in Connection With an FDC

III.i.3.B.3.d. FDCs and Special Issue Development

III.i.3.B.3.e. MST Protocol and FDCs

III.i.3.B.3.f. FDCs and Vet Center Records

III.i.3.B.3.g. Additional Language for FDC Development Letters

III.i.3.B.3.h. Determination to Exclude from the FDC Program After Sending a Development Letter

III.i.3.B.3.i. Telephone Development and FDC Exclusion

4. Determining the Appropriate Effective Date for a Grant of Benefits Under the FDC Program

Introduction

Change Date

III.i.3.B.4.a. Determining the Appropriate Effective Date for a Grant of Benefits Under the FDC Program

III.i.3.B.4.b. Instructions for Applying the Provisions of Section 506 of PL 112-154

III.i.3.B.4.c. Explaining FDC Effective Dates

<iii.i.3.b.4.dIII.i.3.B.4.d. Example 1: Proper Application of the Provisions of Section 506 of PL 112-154</iii.i.3.b.4.d

III.i.3.B.4.e. Example 2: Proper Application of the Provisions of Section 506 of PL 112-154

5. Revisions of FDC Decisions

Introduction

Change Date

III.i.3.B.5.a. Handling Disputes With Exclusion from the FDC Program

III.i.3.B.5.b. Granting the FDC Retroactive Effective Date During the Legacy Appeal Period

6. FDC Folder Flash

Change Date

III.i.3.B.6.a. FDC Folder Flash

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